Fitzgerald S W, Erickson S J, Foley W D, Lipchik E O, Lawson T L
Department of Radiology, Northwestern Memorial Hospital, Chicago, IL 60611.
AJR Am J Roentgenol. 1991 Aug;157(2):331-6. doi: 10.2214/ajr.157.2.1853817.
Most studies of duplex Doppler sonography for the assessment of erectile dysfunction involve determination of peak systolic velocities 5 min after intracavernosal injection of papaverine. The purpose of this study was to determine the effect of the timing of Doppler measurements of flow after papaverine injection for establishing the presence of arterial and venous abnormalities. Color Doppler sonography was performed in 75 patients for evaluation of vasculogenic impotence. After intracavernosal injection of 60 mg of papaverine, measurements of peak systolic and end-diastolic velocities were obtained in each cavernosal artery at 5-min intervals for a total of 30 min. A peak systolic velocity of less than 25 cm/sec was used as the threshold for arterial insufficiency. An end-diastolic velocity of greater than 5 cm/sec was used to predict venous incompetence. Scanning was performed for direct assessment of dorsal venous flow. Thirty patients were subsequently evaluated by cavernosometry and cavernosography. In most patients (76%), maximum response to papaverine was achieved within the first 5 min. In eight patients, significant increases in systolic velocity were seen only after 5 min. In 10 patients, significant changes in end-diastolic velocity between 5 and 30 min resulted in diagnostic reclassification. Data acquisition for 30 min significantly improved the sensitivity (95%) and specificity (83%) for the prediction of venous incompetence in patients with correlative cavernosography. Transient, early dorsal vein flow was noted in normal subjects. Persistent dorsal vein flow had an 80% sensitivity and 100% specificity for venous incompetence. Our results suggest that, when using color Doppler sonography, gathering data for 30 min may improve the prediction of vasculogenic impotence.
大多数关于双功多普勒超声评估勃起功能障碍的研究涉及在海绵体内注射罂粟碱5分钟后测定收缩期峰值流速。本研究的目的是确定罂粟碱注射后血流多普勒测量时间对确定动脉和静脉异常情况的影响。对75例患者进行了彩色多普勒超声检查以评估血管性阳痿。在海绵体内注射60mg罂粟碱后，每隔5分钟测量一次每条海绵体动脉的收缩期峰值流速和舒张末期流速，共测量30分钟。收缩期峰值流速小于25cm/秒被用作动脉供血不足的阈值。舒张末期流速大于5cm/秒被用于预测静脉功能不全。进行扫描以直接评估背静脉血流。随后对30例患者进行了海绵体测压和海绵体造影检查。在大多数患者（76%）中，注射罂粟碱后的最大反应在最初5分钟内出现。在8例患者中，仅在5分钟后收缩期流速才出现显著增加。在10例患者中，5至30分钟之间舒张末期流速的显著变化导致诊断重新分类。在进行海绵体造影检查的患者中，采集30分钟的数据显著提高了预测静脉功能不全的敏感性（95%）和特异性（83%）。在正常受试者中观察到短暂的早期背静脉血流。持续性背静脉血流对静脉功能不全的敏感性为80%，特异性为100%。我们的结果表明，使用彩色多普勒超声时，采集30分钟的数据可能会改善对血管性阳痿的预测。
